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MEDICARE CORNER Legislative History of Medicare: An Overview BY FELICE HANNAH NOTE: The following writing is not intended to fully define the laws of Medicare, but to provide an outline for further research. 1912 President Teddy Roosevelt ran on a platform for a National Health Insurance System 1945 President Truman envisioned National Health Coverage for all Americans • He proposed to have the National Health Coverage for all Americans to be funded through the creation of a National Health Insurance Fund. Beneficiaries would be covered for the cost of doctor and hospital visits, laboratory services, dental care and nursing services. President Truman was unsuccessful in getting his bill passed. 1965 President Lyndon Johnson signed into law Medicare (HR 6675) for those 65 and over • Truman becomes the first enrollee • Title XVII of the Social Security Act “Health Insurance for the Aged and Disabled,” now known as Medicare, is established • Implementation begins in 1966. Persons eligible for Social Security Benefits or Railroad Retirement are covered by Part A and Part B. Individuals would pay a premium for Part B. 1972 President Richard M. Nixon signed into law the expansion of Medicare to include persons under 65 with long-term disabilities. 1997 Congress passed (Public Law 105- 33) Part C • Part C, also known as Medicare Advantage Program, was implemented following the passing of Public Law 105-33. Beneficiaries were given an option to receive health coverage either through Original Medicare, Part A and Part B, or private health plans. 2003 President Bush signs into law the Medicare Modernization Act (MMA) • The MMA, (Public Law 108-173) expanded private sector participation to include Part D Medicare Prescription Drug Program. Some of the Changes created by the MMA are: vBeneficiaries with higher incomes pay a higher Part B fee vSubsidized prescription drug discount cards end and drug coverage through private prescription drug insurance companies begins vGovernment is prohibited from negotiating discounts with drug companies vDrug companies are allowed to establish drug formularies vProvides subsidiaries to large employers to encourage the continuation of drug coverage for retirees 2010 President Obama signs into law the President Obama signs into law The Affordable Care Act Affordable Healthcare Act and Patient Protection Rights (ACA), also known as Obamacare The following is a list of some of the key features of the ACA and Patient Protection Rights: • Ends denial of coverage based on pre-existing conditions for children • Ends denial of coverage based on pre-existing conditions for adults • Adults up to the age of 26 may be covered by parent’s health coverage • Ends arbitrary cancelation of insurance by insurer • Lifetime limits for coverage ended • Preventive health care coverage at no cost to beneficiaries • Emergency care available outside of plan’s network • Integrated Health Systems, such as the Accountable Care Organizations to coordinate care with other doctors and beneficiaries • Affordable Health Insurance through the Market Place Exchange—Small businesses and middle income beneficiaries are given tax credits. • Low income beneficiaries receive Medicaid supplement to pay for the Affordable Health Exchange Insurance • Creating relief for beneficiaries in the ‘donut hole’ by providing discounts for brand and generic drugs on formulary (Prescription drug discount increases thru 2020 when the ‘doughnut hole’ is eliminated) • Created the Community Care Transition Program and Community Health Care Program • Rewarding doctors and hospitals for Quality (not quantity) of care • Premiums cost must primarily be spent on healthcare and not on administrative costs • Limiting beneficiaries Maximum outof pocket cost when enrolled in a Medicare Advantage Plan • Encouraging hospitals and providers to ‘bundle’ payments. For example, claims for a hospital surgical procedure will be submitted as one claim from the surgical team. 2017 President Donald Trump signs Executive Order 13765 The American Health Care Reform Act (H.R.277) is introduced to The House of Representative by Paul Ryan. Changes include: • Repeal the Affordable Care Act and Patient Protection Rights • Current beneficiaries may be allowed to remain on Medicare • Establish a voucher system (premium support) to purchase private insurance • New beneficiaries entering the system after 2024 will be given limited premium subsidy through the voucher system for paying for private insurance • 2015 Bipartisan Budget Act H.R. 1314 calls for reforming Social Security, which will affect the disabled • Beginning in 2018, seniors with incomes at or above $133,00 will pay a higher premium for doctor care and prescription drugs • Limit Medicaid subsidy to states • Changes Employee Retirement Income Security Act of 1974 20  NORTH SHORE TOWERS COURIER  ¢  May 2017


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